Vocational Functioning among People with Psychiatric Disabilities Five to Seven Years after Receiving Supported Employment Services

Article excerpt

The purpose of this study was to report the outcomes from a controlled trial of evidence-based supported employment for people with psychiatric disabilities, five to seven years after participation commenced. Eligible participants from the original multi-site trial of supported employment conducted during 2008-2010 in the South East Queensland region of Australia were contacted by telephone and invited to participate in a follow-up survey. Of the original 266 participants, 74 (27.8%) completed the five to seven year follow-up survey. The results show that the proportion employed during the multi-site trial decreased over five years from 42% employed at any time during the trial to 30% employed in the past six months. However, vocational goals and interests persisted over this time because 92% of those who were previously involved in the employment program continued to be vocationally active or interested in employment as a recovery goal for the future. These results support increasing the availability of more continuous employment services to Australians with psychiatric disabilities.

Little is known about the longer term vocational benefits of supported employment beyond the initial period of employment assistance. Information about employment outcomes beyond two years is scarce because longitudinal studies are costly and with even moderate attrition, the loss of sample size and power can be substantial. Despite these difficulties it is important to know whether intensive vocational rehabilitation programs have lasting vocational effects beyond the initial period of employment assistance. Although at least three longitudinal studies of supported employment have been reported in the USA (McHugo, Drake, & Becker, 1998; Ellison et al., 1999; Salyers et al., 2004), to our knowledge this is the first longitudinal study of this type outside the USA.

The most effective form of supported employment for people with severe and persistent mental illnesses (SPMI) is the Individual Placement and Support (IPS) method (Bond et al., 2008; 2012; Kinoshita et al., 2013; Marshall et al., 2014). This model of supported employment was first implemented in Australia in 2005 and is now available to a limited extent in four of eight states and territories (Waghorn & Hielscher, 2014). Although IPS is effective, it has important limitations indicating there is room for improvement in the employment outcomes attained by this group. For instance, in a successful implementation on average 60% of participants commence employment (Bond, Drake, & Becker, 2008; 2012), while 40% do not attain their initial employment goal.

In terms of the amount and duration of employment, reviews of randomised controlled trials (Bond et al., 2008; 2012; Kinoshita et al., 2013; Marshall et al., 2014) show that the mean hours worked is about 20 hours per week, and employment duration in all jobs average 20 weeks. However, employment durations are underestimated in controlled trials because these are truncated by study follow-up periods of less than one or two years. In the USA most jobs are entry level, and poorly paid compared to Australian jobs. For instance, the mean wages per hour for people with SPMI are $AUD 22.0 in Australia (Morris et al., 2014; Waghorn, Dias, Gladman, Harris, & Saha, 2014) and $USD 8.0 in the USA (Bond et al., 2012). In 2014 the purchasing power parity (OECD, 2016) between the two currencies was 1.47 AUD to the USD. Taking purchasing power into account, the difference between mean wages in favour of Australia was approximately $USD 7.0 per hour. In summary, a limitation of IPS is that a substantial proportion of participants do not commence competitive employment, and of those that do so, most obtain part-time low paying jobs of short duration (Bond et al., 2012).

The primary aim of this study was to describe the employment status and vocational functioning of participants in a multi-site implementation of IPS five to seven years after participation in the supported employment program commenced. …